cmh1118

Thank you, this is a wonderful response. I appreciate you sharing about the malpractice/liability standpoint. That makes a great point about medical presence and EMS transport. I think in the heat of the moment we thought, OK she literally just declined while Mom is right here, it will take an ambulance minutes to show up, the hospital is just right down the street, etc. I totally understand it could have gone bad on the drive there and luckily didn't. I think it was more of "I'm here, I'll accompany her if you'd like" and Mom jumped at it. Looking back is when we thought of all the "what if....."s . Hindsight is of course 2020. I appreciate the reply and it definitely was a learning moment.

Thank you so much for your response and reassurance. I was thinking that myself, about the status dramaticus once Mom showed up. No tripod position, honestly she was just laying down quietly and looked peaceful for the most part. It would just dip when she didn't take some deep breaths, and as soon as she did it would jump back up into high 90's. I appreciate the reply!

Thanks for the assurance. No blue lips, no labored breathing. It definitely did improve her O2% when I made her take deep breaths. It never stayed low, only when she stopped the deep breathing.

9 year old female presents with chills, states "I have breathing problems" No medical history on file, no medications at school. When asked if she has asthma, both her AND MOM say "I don't know". Mom is on the way and the hospital is literally 3 minutes down the road from school. Her pulse ox sat at 95-98% and every 2-3 minutes it would decrease to 90-93% for maybe 10 seconds, then jump back up to 95-98%. At one point the pulse ox read 78% but I'm pretty sure that was a machine error because it immediately jumped back to 94%. Not even two minutes before Mom shows up, she becomes lethargic, pale. Strong carotid pulse but thin radial pulses. Heart rate stable in 80's the entire time. Mottled with cap refill 3 seconds. Able to speak with no distress during transport to ER. The other nurse working with me started workup and I was paged to come help towards the end. Since parents arrived literally a minute after she "hit a wall" the nurse volunteered to ride with them to the ER down the street. Ride was uneventful, she was alert and talkative and pulse ox reads in 94-96%. The child is "completely fine" per Mom, parents told us we over reacted and that she clearly just didn't eat enough breakfast. Covid test pending, but they did not get her a thorough workup. She will have to get one before returning. It looked pretty rough at the end, and I couldn't stop thinking about her last night. I just keep wondering............should we have called 911 at the very beginning of it all? My other nurse is questioning if she did the right thing, hesitant to call if it wasn't a true emergency, since she was fine in the end (per the parents). It obviously could have gotten so much worse so quickly. Just one of those "did I do everything right?" moments. Just curious.........with respiratory issues, what are your guidelines for calling 911?

That's exactly what our policy is. If you get a negative test (or no covid test but alternative diagnosis) you may return. If you refuse to test, or if it's positive, 10 days after onset, improved symptoms, but 72 hours fever free.

OK what COVID-19 related items are you ordering for your office and isolation room? I'm stocked on all regular school year items, but I'm curious as to what I'm missing. Our school received PPE (masks, a few shields and gowns) and I've ordered extra of all my usual things for my makeshift isolation area. Our school is getting a sanitization refill station where the teachers can fill spray bottles with a disinfectant or a sanitizer. I plan to use that but also want my own cleaners. What are your favorites? I've seen a lot of Clorox Healthcare spray with good reviews at schools, but I'm wondering if that's too portent for my asthma kids. I have a great office but it's a bit small; a little scent goes a LONG way. I love Cavicide but can't find too much of that. Thanks for any input!!

Sure, what are you wanting insight on? It's great for inputting immunizations and also running compliance reports, documenting hearing/vision/spinal/AN screenings, you can see all their medical history that's put in upon application, it has a spot for you to document the visit and then send that note to the parent email. At first it was NOT nurse friendly whatsoever, but with updates and now a year later I can say it's very efficient and I really enjoy using it. Let me know what you need help with! My email is [email protected] if you have any specific questions!

Thanks for the response. What a mess but sounds like it was an easy fix. I think she’s so worried the school will be in trouble. I figured they’d work with you and help you get them caught up. They don’t seem like they’re out to close schools for that or anything.

Hi I’m relaying this for a friend who called me hysterical today. She works in Texas at a private school where immunizations are required and only medical exemptions signed by MD are accepted. No conscience exemptions. She just took over a few months ago right before covid hit. The previous nurse was apparently awful. She’s been going through her shot records and so many are insufficient. That part she’s taking care of and getting everyone caught up. However, her principal informed her they underwent an audit in January. Certain shot records were sent in and no results have come back. So my friend is freaking out if they “fail” the audit due to that. Does the school get reprimanded or some kind of demerit? Has anyone been through that or have any knowledge of that? It would be the Texas department of health. I told her to just call them directly and explain and ask what she could do. Any advice? Thanks!

What program do you use now? We use RenWeb through our school. Everything from admin to teachers to medical to after school. It’s all on the same program. The medical portion is very in depth and is their own little chart. When I log my visits there’s an option to send a parent email. I “only” have 400 or so kids, sometimes a quick email works for me.

WOW! that’s a TON of kids. Ours are all dropped off by parents. All great and valid concerns I also worry about. WOW! cameras. That sounds pricey! I also have my handful of parents who admittedly give their febrile kids Advil in the morning and send them on their way. Lovely.

Hi, Are y’all planning to take temps at the door everyday before kids come into school? I have about 400 kids Prek-8th grade. Also what’s your favorite contact-less thermometer? Thank you!

Hi guys, I’m curious on what you keep stocked in your rooms as far as fun distractions....if anything at all. I am not one to let kids wait around forever if it’s something minor. My BS radar is on point and I know my regulars. Especially with corona I know next year will be busy. I have a few kids who just need that quiet space every now and then to come hang out then go back to class. Noisy lunch rooms or loud projects will set them off. A few kids have sensory issues and sometimes a dark, quiet corner can change their whole day. Our counselor is part time so many days these kids will just come hang out with me for a few minutes (given I’m not too swamped or I no contagious kids) My older kids will bring a book or if they’re going home they’ll do homework while waiting. Sometimes it’s hard to even get temps on some of my smaller ones who are terrified of the nurse’s office. I have cute little things on my desk that usually distract them. That or I hand them a glove or cotton ball to play with. I’m just curious if you use anything to just catch their attention and keep kids “busy”. Books to me are just asking for germs. They love to color and I try to keep paper and crayons and just wipe them down. A friend uses those calm down glitter jars and says the kids are mesmerized. Do you have any “fun” in your office?

Does anyone have a pic of how they store their meds? I have 403 kids PreK-8. 2 hemophiliacs, 2 epileptics, 22 Epi Pens. Around 10 asthma inhalers. The rest is OTC meds, topical, etc. I work at a private Catholic school and we cannot apply or administer anything at all without MD orders. So it all ends up in my office. Do you store them separately based on their use, or all alphabetically? For the past few years I’ve just used bins and put them individually in ziploc bags. Then each box holds A-G, H-K, etc. I keep all my Epipens and Diastat in an emergency box so I don’t have to sort through bins. The hemo emergency meds are in my fridge. I’m curious how you keep yours organized and easily accessible!! Thanks for any tips.

I was thinking about that....we may be getting the stock epi pens this year. My bigger concern was the epileptics. Thanks for the reply! It reminds me to ask about the stock meds since that's new to us.